Heroin Detox: Withdrawal Timeline & Treatment

October 17, 2022

Table of Contents

Heroin withdrawal is uncomfortable, with withdrawal often described as flu-like. It potentially lasts a little over a week. After that time, a person will experience a period of generally feeling unwell. They may continue to strongly crave heroin and other opioids for potentially months.

Heroin Withdrawal Symptoms

Withdrawal from heroin (and other opioids) is first characterized by the following symptoms:[1]

  • Agitation
  • Anxiety
  • Difficulty sleeping
  • Heavy sweating
  • Muscle aches
  • Runny nose
  • Teary eyes
  • Yawning

As withdrawal progresses, a person may experience other symptoms, including these:

  • Abdominal cramps
  • Diarrhea
  • Goosebumps
  • Nausea or vomiting
  • Pupil dilation

Withdrawal typically begins mildly. Then, symptoms rise in severity until hitting a peak. After this peak, symptoms lessen until withdrawal subsides.

A person going through withdrawal will usually experience strong drug cravings throughout the process, although at least some of these drug cravings may persist after they undergo withdrawal since they are the result of psychological dependence.

Heroin Withdrawal Timeline

Heroin is a short-acting opioid and can be expected to generally follow a withdrawal timeline as outlined by the World Health Organization.[2] Withdrawal symptoms will usually begin within 8 to 24 hours after a person’s last use of opioids.

Over the course of the next 4 to 10 days, symptoms will first worsen, peak, and then slowly improve. After that, the most severe symptoms will have gone away, but the person will then enter a protracted withdrawal phase for up to 6 months. At this point, they will likely be able to function normally but may feel generally unwell and still experience strong opioid cravings.

It’s important during this protracted withdrawal phase to talk regularly with an addiction treatment professional to maximize your chance of sustained recovery and avoid a relapse. This professional can help you learn to control your drug cravings, identify what draws you to use drugs, and help you develop coping mechanisms to avoid relapse.

Quick Reference Withdrawal Table

Time Since Last Heroin Use Effect
8–24 hours Onset of withdrawal
4–10 days Slow build of withdrawal symptoms until a peak and then a weakening of symptoms
Up to 6 months General feeling of being unwell combined with strong drug cravings

Heroin Withdrawal Management & Related Medications

Several medications can be used to help manage opioid withdrawal symptoms and/or aid in the detox process as part of Medication for Addiction Treatment (MAT). The drugs currently accepted by the FDA for this purpose include the following:

Buprenorphine

Buprenorphine is an opioid partial agonist and often combined with the drug naloxone, called Suboxone.[3] In some ways, buprenorphine acts similarly to full opioid agonists like heroin by binding to opioid receptors and preventing withdrawal symptoms and cravings.

Buprenorphine offers a lower potential for misuse, and the drug has less chance of causing an overdose if misused.

Suboxone can help wean a person off opioids and control their drug cravings. Some people use buprenorphine and then work with their doctor to slowly wean off it once they have more control over their drug use. Others may use it on a long-term basis - even lifelong - to prevent relapse and cravings.

Methadone

In some ways, methadone is used similarly to buprenorphine.[4] Through regular administration at specialized sites, this long-acting opioid agonist can help control a person’s drug cravings.

One major difference from buprenorphine is that methadone is a full opioid agonist. When misused, it has the same effects we typically associate with opioids, including risk of overdose.

Methadone is available only at specialized Methadone Clinics, and is usually dispensed daily to the patient. 

Naltrexone

Naltrexone is different from the other two medications discussed in that it isn’t an opioid and doesn’t have any meaningful misuse potential.[5]

Naltrexone is not an opioid. In fact, it is an opioid antagonist, which means it works by blocking the euphoric and sedative effects of opioids, essentially preventing an individual from “getting high” or experiencing the euphoric effects of opioids.

One downside of naltrexone is a person generally needs to have already gone through withdrawal to use it. Otherwise, it can cause withdrawal symptoms to worsen. For short-acting opioids like heroin, the recommendation is to wait at least a day before starting Naltrexone. [5]

Naltrexone does work to prevent overdose or euphoria after a person takes opioids, but unlike Suboxone and Methadone, it does NOT work by reducing cravings. Therefore it may be slightly less efficacious for some individuals than Methadone or Suboxone. However, it can certainly be a good choice for individuals who are stable in their recovery or who cannot tolerate Methadone or Suboxone for some other reason. 

Heroin Detox & Withdrawal FAQs

How long does heroin withdrawal take?

Opioid withdrawal times can vary, but a person can expect heroin withdrawal to last about 4-10 days. People may still experience strong cravings to use opioids for much longer than this, however. 

Is heroin withdrawal dangerous?

Withdrawal from heroin or any other opioid isn’t usually dangerous or life threatening. While uncomfortable, withdrawal doesn’t pose a major threat to health. 

Can you die from heroin withdrawal?

Essentially, no, you cannot die from heroin withdrawal. Heroin withdrawal is extremely uncomfortable, but it is not life threatening. It is very unlikely that a person would die as a direct result of heroin withdrawal and even more unlikely if undergoing withdrawal under medical supervision, such as at a detox facility or even with a general practitioner’s support.

It's best to have some medical guidance during the detox process to ensure overall comfort. MAT remains the safest and best treatment available for withdrawal from heroin and other opioids.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

Is Suboxone treatment a fit for you?

Contact us directly to speak with a specialist.

Citations

  1. Opiate and Opioid Withdrawal. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm. May 2020. Accessed September 2022.
  2. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/. 2009. Accessed September 2022.
  3. Buprenorphine. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. July 2022. Accessed September 2022.
  4. Methadone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone. June 2022. Accessed September 2022.
  5. Naltrexone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone. April 2022. Accessed September 2022.

Imagine what’s possible on the other side of opioid use disorder.

Our science-backed approach boasts 95% of patients reporting no withdrawal symptoms at 7 days. We can help you achieve easier days and a happier future.

Get Startedor book an enrollment call